The cover story in December 5th’s Newsweek is available online and tackles the science and treatment of anorexia, focusing particularly on why it seems to be increasingly prevalent in children as young as eight.
At a National Institute of Mental Health conference last spring, anorexia’s youngest victims were a small part of the official agenda‚Äîbut they were the only thing anyone talked about in the hallways, says David S. Rosen, a clinical faculty member at the University of Michigan and an eating-disorder specialist. Seven years ago “the idea of seeing a 9- or 10-year-old anorexic would have been shocking and prompted frantic calls to my colleagues. Now we’re seeing kids this age all the time,” Rosen says. There’s no single explanation for the declining age of onset, although greater awareness on the part of parents certainly plays a role. Whatever the reason, these littlest patients, combined with new scientific research on the causes of anorexia, are pushing the clinical community‚Äîand families, and victims‚Äîto come up with new ways of thinking about and treating this devastating disease.
Unfortunately, the article has a somewhat oversimplified account of psychiatrist Walter Kaye’s recent research review and hypothesis about anorexia: that starvation might be a response to a disturbed serotonin system, particularly to high levels at areas in the brain with the serotonin 5HT1A receptor – a system particularly linked to anxiety and obsessiveness.
Starvation might be a response to these effects, as it is known to lower trytophan and steroid hormone metabolism, which, in turn, might reduce serotonin levels at these critical sites and, hence, ward off anxiety.
Importantly, the effects on serotonin levels are often restricted to certain brain areas. Furthermore, studies on a different type of serotonin receptor, the 5HT2A, actually suggest a decrease in serotonin activity at this type of receptor.
Kaye also suggests that disturbance to the serotonin system may arise owing to a combination of genetics, puberty-related hormone changes, stress and cultural pressures – not just a “brain disease”, as one psychiatrist is quoted as saying.
The article does, however, report moving accounts of individuals and families affected by the condition, and contains links to a podcast, including interviews with clinicians and researchers.
Link to article ‘Fighting Anorexia: No One to Blame’ (via PCSD&A).
Link to abstract of Kaye and colleagues article on serotonin and anorexia.
Mind Hacks 
The fact that anorexia/bulimia is connected with anxiety and obsession is nothing new; comorbidity of anorexia/bulimia with depression or OCD is common so it makes sense that it is the result of an underlying predisposition.
The findings of a disturbed serotonin system is interesting and it is a shame—though not a surprise—that newsweek simplified the findings to the point of meaninglessness. As Mind Hacks mentioned, the serotonin system is complex and does not easily reduce itself to simple descriptions.
Another point that stood out for me was: if they are using starvation as a form of self medication to decrease serotonin then why are SSRIs, which increase serotonin, found to be an effective treatment? (Note: SSRIs are effective for treating bulimia during an episode. However the malnourished state of anorexics makes SSRIs almost useless until after they have begun to eat again; at which point, SSRIs are useful to prevent relapse.)
Interestingly, I found another study which points toward serotonin disturbances only being connected with only certain types of anorexia.
http://www.medicalnewstoday.com/medicalnews.php?newsid=30238
As a parent of an anorexic I think the simplicity of the Newsweek piece is a godsend. Although those who follow the research might find the content unremarkable it is the parents out there that really need the news. Doctors aren’t telling them, therapists are rarely telling them, and most of the media about eating disorders is telling them the opposite.
Newsweek has done a revolutionary thing: synthesized the science for the people who really need it.
Parents are still being blamed for their poor parenting – not for their genes – when they bring their ill children for treatment. The message “No One to Blame” is the first step toward getting effective evidence-based care.
Laura Collins
http://www.eatingwithyouranorexic.com